TRICARE Overseas Program

Applied Behavior Analysis

At Knospe-Lerncenter, we are committed to providing accessible ABA services to families covered by TRICARE Overseas Program. Understanding the intricacies of funding and eligibility can be challenging, so we’ve compiled key information to guide you through the process.

Coverage

TRICARE covers clinically necessary and appropriate ABA services for beneficiaries diagnosed with Autism Spectrum Disorder (ASD), as part of the TRICARE Comprehensive Autism Care Demonstration (ACD) program. These services include initial assessments, individual treatment plans, one-on-one ABA services, progress monitoring, and providing treatment advice to family members and caregivers.

Eligibility

  • Autism Care Demonstration (ACD) Eligibility: ABA services under the ACD are available for qualifying Active Duty Family Members, Retirees, and certain National Guard and Reserve members. Eligibility requires enrollment in a TRICARE Health Plan and, for Active Duty Family Members, registration for the Extended Care Health Option (ECHO).
  • ECHO Program: The ECHO program supplements the TRICARE Basic Program and provides supplemental services to eligible family members with qualifying conditions. Beneficiaries can receive authorized ECHO services during a 90-day provisional period, to avoid delays while completing the enrollment process.

FAQ

If your child has an ASD diagnosis, you will need to get a referral to the ACD and a pre-authorization for ABA services. This is mandatory for all TRICARE plans​​.

If you require assistance, please do not hesitate to contact our administrative team.

Requirements include initial evaluation, reassessments every 6 months, annual outcome measures (Vineland-3 and SRS2), and biannual referrals for continued services​​. Our therapists can complete these steps except for the biannual referral, which must be completed by a diagnosing provider.

Occupational Therapy and Speech-Language Pathology

Coverage

Under the TRICARE basic benefit, the following services are covered:

  • Occupational Therapy (OT): OT services focus on enhancing an individual’s ability to perform daily activities and are covered under the TRICARE basic benefit.
  • Speech-Language Pathology (SLP): SLP services, which address communication and swallowing disorders, are also included under the TRICARE basic benefit.

Eligibility

  • Referrals and Pre-Authorizations: For both OT and SLP services, a referral and pre-authorization are typically required. These should be obtained from your TRICARE-authorized Primary Care Manager (PCM) or a specialist approved to diagnose and refer for these services.
  • Selecting Knospe-Lerncenter as your Provider: We operate facilities nearby all MTFs. You can request us as your provider by notifying your referring specialist or PCM.

FAQ

You should start by obtaining a referral from your PCM or an approved specialist. Once you have the referral, submit it for pre-authorization. After receiving approval, you can schedule an appointment with a TRICARE-approved provider.

Yes, OT and ST services are covered under the basic TRICARE benefit for all eligible beneficiaries, ensuring that a wide range of therapeutic needs can be met.

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